Abstract
BACKGROUND: Recently, a novel parameter named admission blood glucose to albumin ratio (AAR) has been proposed and proved to be significantly associated with adverse prognosis of acute myocardial infarction. The prognostic utility of AAR for risk stratification in percutaneous coronary intervention (PCI) treated non-ST-segment elevation acute coronary syndrome (NSTE-ACS) patients has not been well established. METHODS: The present study recruited patients admitted for NSTE-ACS who successfully received PCI. The calculation of AAR involved the division of admission blood glucose by serum albumin concentration. The first occurrence of major adverse cardiovascular and cerebrovascular events (MACCE) was defined as the primary endpoint. The predictive impact of AAR for MACCE was conducted in subgroups according to whether type 2 diabetes mellitus (T2DM) was combined or not. RESULTS: A total of 2107 patients (mean age 60.0 ± 9.0 years; 28.0% female) were included in this analysis. The study documented 293 MACCEs (13.9%), distributed as 128 events in the T2DM subgroup and 165 events in the non-T2DM subgroup. AAR exhibited to be a significant risk predictor for MACCE despite following comprehensive adjustment for confounding factors, either analyzed as a nominal or continuous variable (all P < 0.05). AAR demonstrated superior discriminatory ability for MACCE, achieving the highest area under the receiver operating characteristic curve (AUC = 0.667) compared to its individual components. The addition of AAR to a baseline model yielded the greatest enhancement in MACCE risk stratification compared to its constituent measures, as confirmed by a marked improvement in the Harrell's C-index (from 0.641 to 0.683, P < 0.001), along with significant gains in both continuous net reclassification improvement (0.187, P < 0.001) and integrated discrimination improvement (0.027, P < 0.001). Subgroup analyses revealed that the predictive and stratified value of AAR for MACCE was more significant in patients without T2DM. CONCLUSION: AAR serves as a significant independent predictor for risk stratification in PCI-treated NSTE-ACS patients. The predictive and stratified value of AAR for MACCE seems to be more significant in patients without T2DM.